More than 60 million Americans live in rural communities, where small hospitals strain to stay open amid increasing healthcare demands and dwindling revenue. Today, Nov. 15, 2018, is for them, and for the dedicated healthcare providers among them.

It’s National Rural Health Day, the third Thursday in November designated by the National Organization of State Offices of Rural Health to celebrate rural healthcare providers and call attention to the unique health needs of rural populations. More than 80 small community hospitals have closed since 2010; hundreds of others struggle to survive.

Telehealth services, now offered by several healthcare systems nationwide, have become a lifeline for rural patients who can’t always travel the distances required to reach urban hospitals for care. Physicians and other healthcare providers electronically communicate “face to face” with these patients to help them manage everything from influenza to chronic conditions such as diabetes or congestive heart failure.

But as demand for long-distance healthcare grows, telehealth isn’t the only solution (nor the best one) available to healthcare providers.

A recent study offers yet another push for hospitals to lower elective C-section rates. Research published in the Journal of Allergy and Clinical Immunology, has found a link between C-sections and an increased risk of food allergies. 

C-sections are performed in nearly a third of U.S. births, and half of these surgeries are considered avoidable. Thus, the pressure to lower the rates of this procedure – and it's accompanying risks, which range from infection to excessive blood loss and even maternal death – is mounting from all sides. The Joint Commission, the Centers for Medicare and Medicaid Services (CMS), the National Quality Forum and independent hospital rating firms (such as Leapfrog, which reports on them by hospital) all care about C-section rates. Even media organizations such as Parents.com are weighing in.

All of this puts hospitals in the delicate situation of discouraging elective C-sections, while keeping those patients who request the procedure – without fully understanding the risks – satisfied with their care. Yes, hospitals want to keep their expectant patients happy, but their biggest priority here is maternal and child safety.

So what can hospitals do to help lower C-section rates?

The Joint Commission this year announced a major change for hospitals and health systems seeking advanced, disease-specific, Total Hip and Total Knee Replacement Certification. Hospitals now need to comply with additional performance measures to try to address the top clinical concerns in healthcare today.

The new measures are associated with fewer post-op complications, readmissions and deaths and lower cost – emphasizing how critical it is for healthcare to move the needle in these areas. In addition to focusing on clinical metrics, the Joint Commission is emphasizing the need for patient-reported feedback – once again acknowledging that patients are key partners in reducing healthcare costs. 

Lowering cost, improving post-surgical outcomes and driving patient-reported feedback are lofty goals for the Joint Commission to set for hospitals. But these goals are achievable if hospitals expand how they deliver orthopedic care to include reaching patients outside hospital walls.

Mandatory bundled payment programs for joint replacement offer “more robust, generalizable evidence” than voluntary programs. That’s the main finding of a new study of data from Medicare and the American Hospital Association Annual Survey.

And yet, with the never ending, constantly shifting priorities that hospital staff need to balance, the implication that mandatory bundled payments might be better is a tricky one. This study does not claim definitively that they are. Rather, the authors state, there’s a place for both types of programs in the push to get more hospitals using bundled payment plans. 

The study highlights that the shift to value-based care, particularly in orthopedics, is going strong. The Centers for Medicare and Medicaid Services (CMS) wants to move this transition forward with bundled payments. Whether mandatory or voluntary, it’s wise to proactively get ahead of CMS’s efforts by implementing a patient activation solution that puts you in control.